Associations between sleep duration and depression, mental health, physical health, and general health in U.S. adults: A population-based study

Introduction: Adequate sleep is vital for maintaining mental and physical health. In the United States, a substantial proportion of adults report sleep durations that fall outside the recommended range. Prior research has associated insufficient or excessive sleep with adverse health outcomes; however, few studies have systematically quantified these associations across multiple health indicators using nationally representative data. Objective: This study aims to evaluate the impact of short sleep duration on four key health outcomes: depression diagnosis, number of self-reported poor mental health days, number of physically unhealthy days, and self-rated general health status, using nationally representative U.S. data. Methodology: Methods: We analyzed nationally representative data from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2016 and 2023. Sleep duration was self-reported and categorized into three groups: short sleep (≤5 hours), recommended sleep (6–8 hours), and long sleep (≥9 hours), with short sleep serving as the reference category. The primary health outcomes included: (1) self-reported diagnosis of depression, (2) number of poor mental health days, (3) number of poor physical health days, and (4) self-rated general health, measured on a 5-point Likert scale from excellent to poor. To estimate the effect of sleep duration on these outcomes, we applied Inverse Probability Weighting (IPW) to derive the Average Treatment Effect (ATE), adjusting for key demographic and socioeconomic covariates. All analyses incorporated BRFSS complex survey weights to ensure national representativeness. Results: The study included 318,000 adults (63.3% female; 74.5% White) with a mean age of 51.3 ± 18.4 years. Among individuals with recommended sleep duration (6–8 hours), the baseline prevalence of depression was 39.5% (95% CI: 39.4%–39.7%). Compared to this group, short sleep duration (≤5 hours) was associated with a 14.1 percentage point increase in depression incidence (95% CI: 13.8%–14.4%), while long sleep duration (≥9 hours) was linked to a 12.9 percentage point increase (95% CI: 12.5%–13.3%). Those with short sleep reported an average of 5.3 poor mental health days (95% CI: 5.3–5.4), 4.4 poor physical health days (95% CI: 4.3–4.4), and a higher prevalence of poor general health, 10.0% (0.1, 95% CI: 9.7%–10.2%), compared to individuals with recommended sleep. Similarly, individuals with long sleep duration (≥9 hours) also reported more poor mental (4.6 days, 95% CI: 4.5–4.7) and physical health days (3.2 days, 95% CI: 3.1–3.3), along with a higher prevalence of poor general health, 20.3% (20.3%%, 95% CI 19.4%–21.3%) compared to those with recommended sleep. Conclusion: Both short (≤5 hours) and long (≥9 hours) sleep durations are significantly associated with increased risk of depression, more days of poor mental and physical health, and worse self-rated general health compared to recommended sleep (6–8 hours). Promoting optimal sleep duration through targeted public health interventions, education, and screening may improve population well-being and reduce sleep-related health disparities.